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Guy A, Morange PE, James C. How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms. Blood 2025; 145:1769-1779. [PMID: 39541574 DOI: 10.1182/blood.2024025627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open
Abstract
ABSTRACT Arterial and venous thromboses are the most significant complications in patients with myeloproliferative neoplasms (MPNs), with the primary treatment goal being thrombotic risk reduction. In MPN with no history of thrombosis, primary prevention mainly involves the use of aspirin, and cytoreduction is added in high-risk patients. However, thrombotic complications can unveil an MPN in ∼20% of cases, necessitating the initiation of both antithrombotic therapy for the thrombosis and cytoreductive treatment for the MPN. The duration of anticoagulant therapy after an initial venous thromboembolic event is subject to discussion. Furthermore, the occurrence of a thrombotic complication in patients with a known diagnosis of MPN prompts a reconsideration of both antithrombotic and hematologic management. This review uses case-based discussions to explore the management of thrombotic complications in patients with MPN. It addresses the nature and duration of antithrombotic treatments, as well as the approach to cytoreduction. Special attention is given to the place of direct oral anticoagulants and to the management of patients with MPN with splanchnic vein thrombosis, which is disproportionately common in this group.
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Affiliation(s)
- Alexandre Guy
- Laboratory of Hematology, University Hospital Bordeaux, Pessac, France
- Biologie des Maladies Cardiovasculaires, U-1034, University of Bordeaux, INSERM, Pessac, France
| | - Pierre-Emmanuel Morange
- Laboratory of Hematology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Cardiovasculaire et Nutrition, University of Aix-Marseille, INSERM, Marseille, France
| | - Chloé James
- Laboratory of Hematology, University Hospital Bordeaux, Pessac, France
- Biologie des Maladies Cardiovasculaires, U-1034, University of Bordeaux, INSERM, Pessac, France
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Baysal M, Aksoy E, Bedir KH, Özmen D, Patır P, Demirci U, Yaman S, Özdemir ZN, Gürsoy V, Yıldızhan E, Güven S, Çiftçiler R, İpek Y, Pınar İE, Genç EE, Mersin S, Uğur MC, Karabulut ZT, Hindilerden F, Hindilerden İY, Gulturk E, Cömert M, Karakuş V, Erkut N, Yıldız A, Ümit EG, Demir AM, Küçükkaya RD, Eşkazan AE. Real-world data on direct oral anticoagulants in BCR::ABL1-negative myeloproliferative neoplasms (MPNs): a multicenter retrospective study on behalf of scientific subcommittee on MPNs for Turkish society of hematology. J Thromb Thrombolysis 2025; 58:284-298. [PMID: 39527392 DOI: 10.1007/s11239-024-03043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 11/16/2024]
Abstract
BCR::ABL1-negative myeloproliferative neoplasms (MPNs) pose a substantial risk of thrombosis, leading to significant morbidity and mortality. Anticoagulant therapy, historically based on vitamin K antagonists (VKAs), has limitations in preventing recurrent thrombotic events and managing bleeding complications. Direct oral anticoagulants (DOACs) offer a potential alternative with improved pharmacokinetics and compliance. However, evidence on DOAC efficacy and safety in MPNs remains limited, necessitating further investigation. In this multicenter retrospective study in Türkiye, we assessed real-world usage patterns and outcomes of DOACs in MPN patients. Data from 220 patients with PV, ET, or PMF receiving DOACs or VKAs for thrombosis or nonvalvular atrial fibrillation (NVAF) were collected from medical records. Thrombotic events and bleeding episodes were documented based on ISTH criteria. DOACs were used in 126 patients as first-line anticoagulant therapy or following VKAs. Ninety-four patients were on VKAs, of which 83 as a first-line treatment. There were eight thromboses (6.3%) seen in 126 DOAC patients, and similarly, seven episodes (9.4%) of thrombosis were observed in 94 patients using VKA. Major bleeding occurred in seven patients (5.6%) on DOAC and 3 (3.2%) in VKA. Thrombotic and bleeding risks were comparable between DOACs and VKAs (p = 0.708 and p = 0.158, respectively). The incidence rate of thrombosis in the VKA group is 1.1% and in the DOAC group is 1.9%. The incidence of major bleeding in the VKA group is 0.6% and 1.6% in the DOAC group. To the best of our knowledge, our study included the largest number of MPN patients to date, comparing DOACs with VKA in terms of both efficacy and safety, which suggests DOACs as promising alternatives to VKAs for managing thrombotic risk in MPNs with manageable toxicity. Despite the limitations of retrospective studies, DOACs' benefits in terms of efficacy and compliance warrant further investigation through prospective trials. Individualized treatment decisions should consider patient-specific factors, emphasizing collaborative efforts between specialists to optimize DOAC therapy in patients with MPNs. Comparable efficacy and safety between DOACs and VKAs were observed in MPN patients.
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Affiliation(s)
- Mehmet Baysal
- Division of Hematology, Bursa Ali Osman Sönmez Oncology Hospital, Bursa, Türkiye.
| | - Elif Aksoy
- Hematology Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Kübra Hilal Bedir
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Püsem Patır
- Hematology Clinic, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Türkiye
| | - Ufuk Demirci
- Division of Hematology, Department of Internal Medicine, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Samet Yaman
- Hematology Clinic, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye
| | | | - Vildan Gürsoy
- Hematology Clinic, Bursa City Hospital, Bursa, Türkiye
| | - Esra Yıldızhan
- Hematology Department, Kayseri City Hospital, Kayseri, Türkiye
| | - Serkan Güven
- Hematology Clinic, Mehmet Akif Ersoy State Hospital, Çanakkale, Türkiye
| | - Rafiye Çiftçiler
- Division of Hematology, Department of Internal Medicine, Selcuk University Faculty of Medicine, Konya, Türkiye
| | - Yıldız İpek
- Hematology Clinic, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
| | | | - Emine Eylem Genç
- Hematology Clinic, Tekirdağ Dr. İsmail Fehmi Cumalıoğlu City Hospital, Tekirdağ, Türkiye
| | - Sinan Mersin
- Hematology Clinic, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
| | - Mehmet Can Uğur
- Division of Hematology, Department of Internal Medicine, Çiğli Training and Research Hospital, İzmir Bakırçay University, İzmir, Türkiye
| | - Zeynep Tuğba Karabulut
- Division of Hematology, Department of Internal Medicine, Adana City Hospital, Adana, Türkiye
| | - Fehmi Hindilerden
- Hematology Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - İpek Yönal Hindilerden
- Division of Hematology, Department of Internal Medicine, İstanbul Medical Faculty, İstanbul University, Istanbul, Türkiye
| | - Emine Gulturk
- Hematology Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Melda Cömert
- Division of Hematology, Department of Internal Medicine, Gulhane Training and Research Hospital, Ankara, Türkiye
| | - Volkan Karakuş
- Hematology Clinic, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Türkiye
| | - Nergiz Erkut
- Division of Hematology, Department of Internal Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Abdülkerim Yıldız
- Hematology Clinic, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye
| | - Elif G Ümit
- Division of Hematology, Department of Internal Medicine, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Ahmet Muzaffer Demir
- Division of Hematology, Department of Internal Medicine, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Reyhan Diz Küçükkaya
- Department of Molecular Biology and Genetics, İstanbul University Faculty of Science, Istanbul, Türkiye
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
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Baysal M, Bayrak M, Eşkazan AE. Current evidence on the use of direct oral anticoagulants in patients with myeloproliferative neoplasm: a systematic review. Expert Rev Hematol 2023; 16:131-140. [PMID: 36709432 DOI: 10.1080/17474086.2023.2174515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Thromboembolic events in myeloproliferative neoplasms (MPNs) are one of the most important causes of mortality and morbidity, in which vitamin K antagonists (VKAs) have been used mostly. Recently, direct oral anticoagulants (DOACs) are used in venous thromboembolism (VTE) and cancer-associated thrombosis (CAT). With the adoption of data from CAT and VTE, the usage of DOACs in MPNs is increasing. AREAS COVERED In this paper, we performed a systematic review to the current literature regarding the usage of DOACs in MPNs. Eleven studies involving 944 patients were included. The reasons for initiating DOACs were secondary prophylaxis for thrombosis (arterial or venous) and atrial fibrillation (AF) in 562 and 382 patients, respectively. A total of 84 (8.9%) recurrent thrombotic (arterial or venous) events recorded. Forty-six (8.1%) events occurred in the thrombosis group (arterial or venous) and 38 (9.9%) events occurred in patients with AF. EXPERT OPINION Ease of management and patient comfort should be regarded as benefits of DOACs compared to VKAs. However, it would be appropriate to bring an individualized approach until we obtain high-quality data with prospectively designed studies involving more patients and longer follow-up time concerning the use of DOACs in patients with MPNs.
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Affiliation(s)
- Mehmet Baysal
- Division of Hematology, Ali Osman Sönmez Oncology Hospital, Bursa, Turkey
| | - Meltem Bayrak
- Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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